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Maternal Health

Improving Service Delivery through service guarantee: Implementation of Janani Sishu Surakshya Karyakram (JSSK)
“Janani Shishu Suraksha Karyakram” is a programme that invokes a new approach to   health care delivery, for the first time, giving utmost emphasis on entitlements and seeking to eliminate out- of –pocket expenses for both pregnant women and sick neonates.  The initiative entitles all pregnant women delivering in public health institutions to absolutely free and no out of pocket expense delivery, including caesarean section. The entitlements includes free drugs and consumables, free diagnostics, free blood wherever required, and free diet for 3 days during normal delivery and 7 days for C-section.  This initiative also provides for free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns and infants accessing public health institutions. This has now been expanded to cover the complications during ANC, PNC and also sick infants.
       During the year 2012-13, 6,02,062 institutional deliveries had taken place out of which 4,62,815 ( 76.87%) pregnant women and 1,16,692 sick newborns have received JSSK services.

Reduction of   MMR and Provision of Quality ANC:

Ante natal Care
             It is very important to get the pregnant women in our institutional fold as early as possible so that we have a wider opportunity for service delivery. Thus, it is important to ensure that   every pregnant woman is registered within 12 weeks and she receives 4 ANCs, complications if any, are identified in time, referred if required and managed. It is mandatory that all the services to pregnant women and infants are delivered   using Mother Child Tracking System (MCTS) portal.

Comprehensive abortion services, Implementation of MTP Act

Safe Abortion Services:
Unsafe Abortion is another important cause which also leads to maternal deaths. Such deaths can be prevented by the provision of safe abortion services. Operationalizing public health facilities for provision of quality safe abortion services a committee has been formed which meets regularly for safe abortion service provision. About 297 Medical Officers has been trained since 2005 on MTP and 103 ANMs and Staff Nurses have been trained to provide confidential counselling for MTP and post abortion care. At present 32 DHH, 25 SDH, 314 CHC & 78 PPC are providing safe abortion services in the state.

Implementation status of Maternal Death Review:

Maternal Death Review:
Every maternal death whether at the facility or in the community is being reviewed at different stages. Such review is not for any punitive action but for improving the service delivery of the system. According to the Maternal Death reports of 2012-13, 1034 deaths have occurred of which 78% are facility based deaths and 22% are community deaths. All the deaths are reviewed for analyzing the cause and take remedial steps accordingly.

Facility Operationalization: FRUs, 24x7 PHCs as delivery points
Provision of maternal and newborn care through a continuum of care approach, ensuring care during critical periods of delivery and postnatal period, thereby addressing the needs of the mother and the newborn through a seamless transition from home and village to the facility and back again has been the prime focus. For this the facility operationalization through provision of services is very essential. There are total 700 Delivery points during 2012-13 of which 561 are functional and during 2013-14 another 11 nos. of DPs has been added. Out of 711 targeted delivery points 460 institutions are giving assured BeMOC and 73 institutions proving assured CEmOc services. It has been decided by Govt. to operationalise 94 FRUs out of 145 as per the population norm i.e. 5 lakhs per FRU.

Capacity Building: Taking Stock of Trainings - EmOC, LSAS, BeMOC & SBA, MTP
The availability of assured services at identified BeMOC & CEmOC facilities is critical for reduction of maternal & infant mortality and morbidity. Lack of specialists and adequately trained and skilled manpower is a major bottleneck in achieving this. To overcome this, a policy decision was taken for training of MBBS doctors in various obstetric and anaesthetic skills, so that quality services can be timely rendered particularly during obstetric emergencies and also on demand for safe abortion services. The capacity building of medical officers and nursing personnel were initiated to improve provision of emergency and essential obstetric care services at the district, sub-district and other health facilities. LSAS, EmOC, BeMOC and SBA training are being undertaken at Medical Colleges, SI H & FW Conference Hall, Health and FW Centers, ANMTCs, GNMTCs, DTUs loaded DHHs/FRUs.
Accreditation of training centres as per GoI norms and regular monitoring along with supervision of these trainings are key factors in maintaining the quality of the training.  

Review on implementation of JSY
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM). It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among pregnant women by providing cash incentive for opting institutional delivery.

Tracking each pregnancy:  Each beneficiary registered under JSY scheme should have a JSY card along with a Mother and Child Protection Card (MCP). An identified link worker, such as an ASHA/ Anganwadi Worker (AWW), should mandatorily prepare a micro-birth plan for each beneficiary under the overall supervision of the ANM and the Medical Officer at the Primary Health Centre (PHC).

Implementation of RTI/STI Services
RTIs including STIs cause suffering for both men and women around the world, but their consequences are far more devastating and widespread among women than men. The RTI/ STIs account for the largest burden of morbidity and mortality among women after pregnancy related causes. Having an STI increases the risk of HIV transmission by 3 fold, regardless of whether it is the HIV-positive partner or the HIV-negative partner who has the STI. Keeping this in view National RTI/STI Programme has focus on screening, management and counselling of RTI/STI both in male and female.
55 Medical Officers, 49 LTs and 21 Staff Nurses are trained in Syndromic case management. Inclusion of HIV screening in routine ANC Check up in NACP high focuses districts. For HIV screening of pregnant mothers ICTCs and ICTCs are being strengthened.  1,64,664 ANC mothers tested for HIV 7 A&B category districts  and out of that 181 positive cases have been detected.

YEAR No. of cases(2012-2013) No. of Facility - 2012-13
TOTAL 26858 2895 74787 0 25 13 190 0 228

Tracking of Severe Anaemia
We have a high burden of anaemia and   almost more than 50% of the women are anaemic.   Severely  anaemic women  particularly   during pregnancy  is more prone to  develop  life threatening  complications  and as such  anaemia  in  general  and severe  anaemia in particular  needs a   special attention  and focus.
 The severely anaemic women are to be tracked and monitored through MCTS and   records of such women are kept separately at all Sub- Centres and PHCs for   active follow-up by ANMs and MOs.  In Village Health and Nutrition Days the Hb is being measured but the issue of accuracy is still a challenge. The status of pregnant women according to MCTS registration is 7,61,989 out of which 94,226 are with Hb <11 and 957 are with <7 as per the record updates till 30/06/13.

MCH wings
Under NRHM, creation of a 100 bedded MCH Wings in District Hospitals/ District Women Hospitals has been initiated in order to overcome the constraint of limited number of beds at health facilities in the face of increasing case loads and institutional deliveries. This wing to be completed in next 2-3 years will have integrated facilities for advanced obstetric and neonatal care including all relevant equipments and trained manpower.  This will not only create scope for quality services but also ensure 48 hours stay for the mother and baby at the hospital.  The progress of setting up of 100 beded MCH wings is carried in 11 districts of the state.

Implementation of National Ambulance Service:-
An effective perinatal referral transport service is critical for preventing maternal deaths in India. It enables a pregnant woman for reaching a facility in time where she and her baby can receive appropriate care.  It is also important that every model of referral transport provides a minimum acceptable level of services at an optimal cost. Presently there are 185 nos of BLS and 422 nos of State Ambulances and 420 Janani Express running under PPP mode at present. Ambulances under 108 Emergency Service are linked with a centralized 24X7 call centre. 

The Village Health and Nutrition Day has been adopted by the National Rural Health Mission (NRHM) of the Government of India as a priority intervention. The key objective is toincrease access and coverage of basic health and nutrition services for rural communities through monthly service delivery in each village providing multiple services on a fixed day, fixed time and at a fixed place. It is envisaged that services will be provided through the collaboration of three frontline workers, the ANM, ASHA and AWW, from the Departments of Health and Family Welfare (HFW) and Women and Child Development (WCD).

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